Measles

Late last year we had a major outbreak of measles within the Kunene region, the disease having crossed over the border from Angola.

Because of the lack of immunity in the population combined with a transient lifestyle and close living conditions it spread very quickly, sadly resulting in a number of deaths of people who had underlying conditions and were in many cases already immunocompromised.

The Ministry of Health and Social Services instigated an emergency response in the region and received assistance from far and wide to help fight the outbreak.

Some of the assistance included:

Tents for an isolation unit provided and setup by the NDF (Namibian Defence Force)

NDF ambulances (tank ambulances), nurses and doctors

Nurses from other regions

Technical support teams from national level

Epidemiological support from the WHO

In the end we had three special rounds of immunisation – starting with children 6 months to 5 years and ending up immunising anyone of any age.

New Cases of Measles in Opuwo District (nb reports from outlying clinics often delayed)

Our biggest problem was reaching everywhere in time – the Opuwo District is particularly sparsely populated and rugged so everyone took part in the effort, I even contributed in a small way.

From the graph above you can see what a major impact the response had – the immunisation campaigns were held from around week 44/45 onwards. By the end of January 2010 new cases had dropped to almost nothing and by pushing ahead with one further round of immunisations hopefully that will be the end of it.

What this shows I feel, apart from the importance of clear focus on emergencies and prompt responses is the simple message that routine immunisation works. Other places with a much higher rate of immunisation (a higher “herd immunity” to use epi-doc-speak) simply wouldn’t have had anywhere near the rate of infection.

Prior to this outbreak we would often find some Himba communities reluctant to take part in vaccination campaigns. A post-appartheid legacy of not trusting the government, word-of-mouth tales of adverse reactions (and of course actual adverse reactions, many children will have a small and brief fever after immunisation) and a trust in traditional healers all played a part. Really it was a more forgivable version of the UK MMR fiasco.

Sad though the outbreak was the one positive result has been a marked change in attitudes in the community. Everyone knew someone who was infected and given the small population everyone knows of someone who passed away. Towards the end of our special campaign (and in routine campaigns since) we have had people queuing up to have their children (and themselves in some cases) immunised.